| NPI | 1699969436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225700000X Massage Therapist (Licence: AK 1220) | |
| 226300000X Kinesiotherapist | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-09-05 |