| NPI | 1598874265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36858) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2140) |
| 225100000X Physical Therapist (Licence: MA 19894) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-06-19 |