| NPI | 1467535245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1165568) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX 1165568) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2024-10-30 |