| NPI | 1982171252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH UC833201) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2018-10-25 |