| NPI | 1841451424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ MT00834) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: UT 6735789-4701) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2014-02-18 |