| NPI | 1114474723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT4227) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2021-05-11 |