| NPI | 1942654157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL ma95194) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA 26599) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2023-12-20 |