| NPI | 1619297462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 023459-1) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 006279-1) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2010-06-03 |