| NPI | 1770785834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NC 3728) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA10822) |
| 225700000X Massage Therapist (Licence: FL MA9393) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2018-03-17 |