| NPI | 1407474919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA100038) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227022111) |
| 226300000X Kinesiotherapist (Licence: IL 2055) | |
| 226300000X Kinesiotherapist (Licence: FL 2055) | |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2023-05-15 |