| NPI | 1912780792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL 13839) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 13839) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2023-09-22 |