| NPI | 1891725073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CO 0003770) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: OH PT015049) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT004538) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2022-07-21 |