| NPI | 1821485467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2083467) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT027078) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2015-04-21 |