| NPI | 1720320336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 19235) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR LMT-19235) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2020-03-13 |