| NPI | 1568418705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT22446) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9113) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2018-02-13 |