| NPI | 1154443281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT21657) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2012-09-28 |