| NPI | 1902233208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2022-0786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9388) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2024-11-15 |