NPI | 1083772446 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007254) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA PT007254) |
Enumeration Date | 2006-12-05 |
Last Update Date | 2023-05-09 |