| NPI | 1093267510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX 118681) |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: CO 201073074) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-11-01 |