| NPI | 1235522749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 20742) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NM 7779) |
| Enumeration Date | 2015-03-08 |
| Last Update Date | 2015-03-08 |