| NPI | 1942313424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ MT08447) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06002128A) |
| 225700000X Massage Therapist (Licence: FL MA 37184) | |
| 225700000X Massage Therapist (Licence: WA MA 00007960) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2013-01-28 |