| NPI | 1831469196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CT T58152) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225700000X Massage Therapist (Licence: CT 002967) | |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2017-01-31 |