| NPI | 1326652884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist |
| Additional Taxonomies | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: FL MA51576) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |