| NPI | 1952723785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PTA23648) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: FL PTA 23648) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2020-05-12 |