| NPI | 1215461579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NE 3205) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IA 04115) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2017-04-13 |