| NPI | 1336135656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 022859) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2021-03-24 |