| NPI | 1477042638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019636) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0134683) |
| 225200000X Physical Therapy Assistant (Licence: NY 011683) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2024-03-20 |