| NPI | 1699891655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA20982) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA 38578) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2012-03-13 |