| NPI | 1568626679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 225700000X Massage Therapist |
| 3747A0650X Technician, Attendant Care Provider | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2008-07-17 |