| NPI | 1336299023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO 53181) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO 91748) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-08 |