| NPI | 1477850766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: PA MSG000336) |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: PA 217043) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2011-02-22 |