NPI | 1154569192 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11859) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC 11859) |
Enumeration Date | 2009-01-29 |
Last Update Date | 2023-08-14 |