| NPI | 1437764313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39673) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: GA MT012759) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2022-12-22 |