| NPI | 1811494438 |
|---|---|
| Former Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: PR 000217) |
| Additional Taxonomies | 173C00000X Reflexologist (Licence: PR 000217) |
| 226300000X Kinesiotherapist (Licence: PR 000217) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2018-04-10 |