| NPI | 1093268492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37184) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL R200630943740) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2022-07-18 |