| NPI | 1528331410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AK PHAP2022) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MT 27257) |
| 225700000X Massage Therapist (Licence: AK 227304) | |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2024-10-16 |