| NPI | 1144355686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT20991) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA9574) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2021-11-11 |