| NPI | 1316218506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TN 0000008281) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: TN 0000008281) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2014-02-08 |