| NPI | 1235379801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 013920) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NY 321853) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2009-02-23 |