| NPI | 1164889390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M04919) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: DC MT1474) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-01-19 |