| NPI | 1275011892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MA 9984) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NH 1528) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2018-08-06 |