| NPI | 1528478930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA LA7163) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: LA LA7163) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2014-05-07 |