| NPI | 1902030802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 226300000X Kinesiotherapist (Licence: FL MA21615) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA21615) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2009-05-06 |