| NPI | 1093947962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 018195-1) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 018195) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2019-09-30 |