| NPI | 1588848600 |
|---|---|
| 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: CO PTL.0010927) |
| 225100000X Physical Therapist (Licence: CA 33990) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2023-04-06 |