| NPI | 1487976833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24998) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: FL 24998) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2023-01-11 |