| NPI | 1427255629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36487) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA49543) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2025-03-13 |