| NPI | 1437665296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00024476) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO MT.0010363) |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2017-12-15 |