| NPI | 1437201720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OH 33.015535) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KY KY-2259) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2010-04-12 |