| NPI | 1821240102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT008808) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA PT008808) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2019-04-09 |