| NPI | 1659986487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA33593) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA22449) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2020-09-23 |