| NPI | 1144438573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26804) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9996) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2018-02-22 |