| NPI | 1528210564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE007447) |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2008-10-22 |