| NPI | 1730189069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WI 718-046) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 469-019) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2025-09-11 |