| NPI | 1598047995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MA 8508) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NH 3460M) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2011-09-13 |