| NPI | 1215179940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA37705) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL pta21169) |
| Enumeration Date | 2009-03-26 |
| Last Update Date | 2010-11-10 |