| NPI | 1477005254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MI 75010003128) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502004901) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2023-10-17 |