| NPI | 1568838126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 002529741) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2020-05-20 |