| NPI | 1164833638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NV NVMT6718) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA61455) |
| Enumeration Date | 2014-05-18 |
| Last Update Date | 2014-05-20 |