| NPI | 1902202617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN 5825) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TN 4302) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |