| NPI | 1124273164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 118267) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MO 2006032884) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2008-11-18 |