| NPI | 1841609856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ID MAS-3256) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NM 7258) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2020-04-22 |