| NPI | 1528459641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 6177) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT-8685) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2025-05-29 |