| NPI | 1548049398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MI 7501017157) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| 225200000X Physical Therapy Assistant (Licence: MI 5502008448) | |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2025-10-17 |