| NPI | 1417372061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OH 33018293) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WV 2009-2615) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2014-02-19 |