| NPI | 1821434762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33239) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2018-03-17 |