| NPI | 1780215657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist Physical Rehabilitation (Licence: OH OT011233) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT003966) |
| 225XP0019X Occupational Therapist Physical Rehabilitation (Licence: IN 31007078A) | |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2024-12-18 |