| NPI | 1740646025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NC 15275) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: SC 10057) |
| Enumeration Date | 2016-01-03 |
| Last Update Date | 2016-01-03 |