| NPI | 1245628668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX 110863) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: ID 1611) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-01-07 |