| NPI | 1043772155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: FL MA92236) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA92236) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2025-02-19 |