| NPI | 1083158539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 22449) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 22449) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2022-03-21 |