| NPI | 1427368323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KY KY-2031) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KY 526987-07) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2014-11-17 |