| NPI | 1396085403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WI 12209-146) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ mt-15496) |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2013-02-26 |