| NPI | 1932727500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT003890) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA012094) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-07-23 |