| NPI | 1679808760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: AZ MT-08525) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ MT-08525) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2018-03-17 |