| NPI | 1184812901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2020657) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT027685) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2007-10-05 |