| NPI | 1689808966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA25249) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA 54921) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2014-10-30 |