| NPI | 1689119067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33322) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225100000X Physical Therapist (Licence: GA PT017553) | |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2025-02-18 |