| NPI | 1831210046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KY KY-1628) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33-014292) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |