| NPI | 1881945566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT5070) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MS PT5070) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2023-12-15 |