| NPI | 1548401565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 16167) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NM 6431) |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2013-07-16 |