| NPI | 1104345230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WY OL1733448) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO 0019960) |
| Enumeration Date | 2017-09-09 |
| Last Update Date | 2017-09-09 |