| NPI | 1578106274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 226300000X Kinesiotherapist (Licence: 1060542) |
| Additional Taxonomies | 225700000X Massage Therapist |
| 251K00000X Public Health or Welfare | |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2019-10-25 |