| NPI | 1295495810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP039611T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT210002194) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2025-01-23 |