| NPI | 1376939553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MS 823) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: MS 823) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2015-04-14 |