| NPI | 1013004829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NC 22423) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 11930) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-04-11 |