| NPI | 1538675210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34137) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: FL PT34137) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2020-08-23 |