| NPI | 1013364579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NJ 18KT00654600) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 027893-1) |
| Enumeration Date | 2016-05-15 |
| Last Update Date | 2016-05-15 |