| NPI | 1275784357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NC 15472) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: GA MT003701) |
| 225700000X Massage Therapist (Licence: CO MT.0019096) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2017-02-24 |