| NPI | 1649480179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NM LMT #2966) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX LMT#MT045474) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |