| NPI | 1316958226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: TX 017023) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT017023) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2024-09-02 |