| NPI | 1972713113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MS MT852) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MS OT1893) |
| 225X00000X Occupational Therapist (Licence: AR OTR451) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-09 |