| NPI | 1518237296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA 00017830) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NV 557) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |