| NPI | 1134862881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29154) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225100000X Physical Therapist (Licence: VA 2305215328) | |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2023-12-12 |