| NPI | 1700577947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA71263) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA26159) |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2023-05-18 |