| NPI | 1689015612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: SC MAS.8495R) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT109593) |
| Enumeration Date | 2013-07-06 |
| Last Update Date | 2013-07-06 |