| NPI | 1730481169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: IL 227-003757) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2016-09-22 |