| NPI | 1770683583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32333) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA 18956) |
| 225700000X Massage Therapist (Licence: FL MA35991) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2017-02-14 |