| NPI | 1437362415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 004340) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 019749) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2025-09-11 |