| NPI | 1124418934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA25367) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA59111) |
| Enumeration Date | 2015-02-01 |
| Last Update Date | 2017-08-11 |