| NPI | 1275851370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: CO 0014740) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 023518) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2020-12-09 |