| NPI | 1134320229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA 18846) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA 35157) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-11-08 |