| NPI | 1528200243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO 1987) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 56792) |
| Enumeration Date | 2009-03-26 |
| Last Update Date | 2009-03-26 |