| NPI | 1720359433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: GA MT004920) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: GA MT004920) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2012-02-27 |