| NPI | 1689224792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PT35041) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT35041) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |