| NPI | 1144259342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT20931) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH0008906) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2022-08-31 |