| NPI | 1750602090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: IA 005795) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227.010795) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2010-06-22 |