| NPI | 1134760499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO 0003492) |
| Additional Taxonomies | 225700000X Massage Therapist |
| 225700000X Massage Therapist | |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2019-10-07 |