| NPI | 1427008556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT21887) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA32752) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-01-05 |