| NPI | 1386919504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA22466) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306602672) |
| 225700000X Massage Therapist (Licence: FL MA 67352) | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |