| NPI | 1740558584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA26844) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA 64023) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2024-03-21 |