| NPI | 1659741593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1268467) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2024-07-18 |