| NPI | 1356808497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL HCC11651) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL HCC11651) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2019-02-25 |