| NPI | 1477892156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: HI MAT-13111) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 27339) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2013-01-31 |