| NPI | 1598854531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 060402628) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 500748-05) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |