| NPI | 1558838219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60889660) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ Mt-24682) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2018-12-06 |