NPI | 1831691948 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider |
Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 7811204-2402) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-03-05 |
Last Update Date | 2023-08-03 |