| NPI | 1740728625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA 60640622) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MI 7501001797) |
| 225700000X Massage Therapist (Licence: TX MT115984) | |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2017-02-10 |