| 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 |