| NPI | 1063697787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ 22514) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 10773) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2021-02-15 |