| NPI | 1629205257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00025146) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA38057) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2009-06-22 |