| NPI | 1740599299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 25905) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA52832) |
| 225700000X Massage Therapist (Licence: NY 008631) | |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2019-09-24 |