| NPI | 1760870711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34892) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY AT1093) |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2019-09-10 |