| NPI | 1245899475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: IA 083354) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IA P29320) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |