| NPI | 1386979458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60112428) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT4150) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2010-11-08 |