| NPI | 1083949713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MS 6207) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: LA 3352) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2022-03-29 |