| NPI | 1336325380 |
|---|---|
| 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: NE 2287) |
| 225100000X Physical Therapist (Licence: IA 4103) | |
| Enumeration Date | 2008-01-20 |
| Last Update Date | 2026-06-10 |