| NPI | 1205147352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CT 004158) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA79049) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CT xxxxxx) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CT xxxxxx) | |
| 225400000X Rehabilitation Practitioner | |
| 225700000X Massage Therapist (Licence: RI MT01411) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2019-10-08 |