| NPI | 1518297027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO 8934) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NM 5170) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2011-05-12 |