| NPI | 1164731956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MT LMT-LMT-LIC-3) |
| Additional Taxonomies | 174400000X Specialist (Licence: MT LMT-LMT-LIC-3) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2024-10-28 |