| NPI | 1073804894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 24946) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL 43135) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |