| NPI | 1912124546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: FL 299993612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 13392) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2012-09-18 |