| NPI | 1285641084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT12249) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9234) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2008-04-18 |