| NPI | 1780957910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA60762) |
| Enumeration Date | 2012-02-19 |
| Last Update Date | 2015-09-30 |