| NPI | 1770794018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 23463) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NM 0008) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2019-06-25 |