| NPI | 1346605318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M05495) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 198410) |
| 225700000X Massage Therapist (Licence: NC 01053) | |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2015-12-17 |