| NPI | 1306292008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: TX 02242001) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT032379) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2016-05-11 |