| NPI | 1104844216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R81303) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT9151) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-09-06 |