| NPI | 1326488461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO MT0014602) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CO 0330922) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2013-07-03 |