| NPI | 1902124068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: NY 019612-1) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NJ 26BT00183100) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-13 |