| NPI | 1295088367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: PR 802) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: PA MSG004108) |
| 225700000X Massage Therapist (Licence: PR 00-25) | |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2020-02-06 |