| NPI | 1477813871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ MT-03432P) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: AZ MT-03432P) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |