| NPI | 1154898799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1312392) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 1312392) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2023-08-14 |