| NPI | 1316906605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT19632) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: FL PT19632) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-03-06 |