| NPI | 1942846035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1326549) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX 1326549) |
| Enumeration Date | 2019-11-23 |
| Last Update Date | 2022-04-13 |