| NPI | 1396992442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34034) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA88437) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2018-11-15 |