| NPI | 1245416833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NM 4612) |
| Additional Taxonomies | 172M00000X Mechanotherapist |
| 174400000X Specialist | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-01-14 |