| NPI | 1710016506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MA41715) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL MA41715) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2012-03-13 |