| NPI | 1932174810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 017085) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2025-02-28 |