| NPI | 1780927921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: GA MT009008) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 11488) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2013-04-05 |