| NPI | 1780172999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23457) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2023-03-23 |