| NPI | 1548086564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Additional Taxonomies | 174H00000X Health Educator |
| 2251S0007X Physical Therapist, Sports | |
| Enumeration Date | 2024-11-25 |
| Last Update Date | 2024-11-25 |