| NPI | 1629328174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA29361) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA64134) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2019-11-12 |