| NPI | 1629418686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT119934) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NV NVMT.5365) |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2019-09-28 |