| NPI | 1821377839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PTA26031) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA44895) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2015-09-09 |