| NPI | 1376053520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212173) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2021-01-24 |