| NPI | 1790169225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4575) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NV NVMT.9396) |
| 225700000X Massage Therapist (Licence: HI MAT-13654) | |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2025-01-24 |