| NPI | 1164031498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: HI MAT-16389) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: HI OTA-179) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2020-07-22 |