| NPI | 1336593359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV 21030312600) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2021-11-12 |