| 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 |