| NPI | 1578752549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA27822) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA19949) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2018-11-28 |