| NPI | 1487906574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: PA MSG005947) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: PA MSG005947) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2012-10-15 |