| NPI | 1467857854 |
|---|---|
| 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: CA 10441) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2024-05-07 |