| NPI | 1922676352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 305784) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2024-04-09 |