NPI | 1275701450 |
---|---|
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: MI 5501010890) |
Enumeration Date | 2008-02-11 |
Last Update Date | 2023-04-12 |