| NPI | 1225333461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA61559) |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2022-10-09 |