| NPI | 1831118629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT5152) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH5693) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-07-23 |