| NPI | 1811147507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OH 33.010323) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00012252) |
| 225700000X Massage Therapist (Licence: FL MA 53620) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2008-09-30 |