| NPI | 1790169860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KLUCHUROSKY Sports Medicine Program Manager 614-355-6020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT.004136) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |