| NPI | 1326464553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046932) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016590) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2020-06-18 |