| NPI | 1669014767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MO 2002017980) |
| Additional Taxonomies | 2472E0500X Technician, Other, EEG |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2019-10-10 |