| NPI | 1952940413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: FL PT35348) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT35348) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2025-10-31 |