| NPI | 1437847316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY CP034874T) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2025-01-06 |