| NPI | 1366978553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AK 106943) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AK 101564) |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2022-09-22 |