| NPI | 1255390845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NY 018349-1) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2022-12-22 |