| NPI | 1316287097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT112853) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ MT-15072) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2013-02-22 |