| NPI | 1992715460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 1242) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NM 4329) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2007-07-08 |