| NPI | 1184932964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL 1188jtc) |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2011-07-22 |