| NPI | 1235450750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: SC 6643) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 9451) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2010-06-18 |