| NPI | 1700329075 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MI L891159) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2017-06-01 |