| NPI | 1821371337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA27278) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225700000X Massage Therapist (Licence: FL MA 56546) | |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2022-05-20 |