| NPI | 1518326966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33870) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL AL4212) |
| Enumeration Date | 2016-02-13 |
| Last Update Date | 2023-12-20 |