| NPI | 1578118618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.259284) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic |
| 2251X0800X Physical Therapist Orthopedic (Licence: OH PT016847) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2025-08-06 |