| NPI | 1134735020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NV NVMT.8584) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 55910) |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2020-09-16 |