| NPI | 1609320001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013651) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26412) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC 626156) | |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2018-10-25 |