| NPI | 1770940330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OH 33-021101) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 08913) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2016-01-27 |