| NPI | 1588978498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2074248) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT046366) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2013-07-23 |