| NPI | 1356746341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA50835) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA23653) |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2016-01-07 |