| NPI | 1881574655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MI 7501008827) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502006333) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-09-03 |