| NPI | 1104045525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OH 33.016536-L-M) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00020346) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2009-10-20 |