| NPI | 1093395394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: VA 2306605845) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019011669) |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2021-04-11 |