NPI | 1962800730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IL 160004131) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA30239) |
225700000X Massage Therapist (Licence: FL MA95767) | |
Enumeration Date | 2014-12-10 |
Last Update Date | 2021-09-16 |