| NPI | 1306140983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60197511) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 27 023941) |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2010-12-22 |