| NPI | 1942413984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 7593) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT1521) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-03-22 |