| NPI | 1467820423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 021112) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60537199) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |