| NPI | 1285610360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT2257) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH0005375) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2008-06-18 |