| NPI | 1689050601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 38336) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA63882) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2022-03-29 |