| NPI | 1093949349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2003059) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT000278) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2009-05-14 |