| NPI | 1912484684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2231) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2018-11-06 |