| NPI | 1164760526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: PA Msg000218) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2013-01-19 |
| Last Update Date | 2019-06-28 |