| NPI | 1164819926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ID MAS-2376) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: UT 6897414-4701) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2015-04-20 |