| NPI | 1164741336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 8351) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MA 6397) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2010-05-26 |