| NPI | 1609034511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OH 6374) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 123412) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2008-05-28 |