| NPI | 1821441577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MA 6291) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 3729) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |