| NPI | 1508269762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41564) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2024-06-29 |