| NPI | 1306096011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA25419) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA46357) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2020-03-10 |