| NPI | 1356043376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37178) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA92229) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2025-07-14 |