| NPI | 1376791079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AL 5456) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AL 5880) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2023-09-06 |