| NPI | 1932401759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: FL 25858) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2020-02-13 |