| NPI | 1396883922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA18042) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA17264) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2025-09-11 |