| NPI | 1497053177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA26511) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA61608) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2016-08-28 |