| NPI | 1760780696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NV 3071) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00025067) |
| 225700000X Massage Therapist (Licence: MO 2002000659) | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2011-03-01 |