| NPI | 1043610678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 37783) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2025-04-14 |