| NPI | 1447639083 |
|---|---|
| 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: ID PTA-2959) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2020-03-31 |