| NPI | 1659837292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61442220) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000050565) |
| 376K00000X Nurse's Aide (Licence: MT 353331) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2023-05-24 |