| NPI | 1598006819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: TX 106199) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX 106199) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2013-03-12 |