| NPI | 1356948905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA27621) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2026-04-08 |