| 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 |