| NPI | 1801344577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AK 130033) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT123921) |
| 225700000X Massage Therapist (Licence: CO MT.0015832) | |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2020-04-10 |