| NPI | 1871041392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 23713) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NE 3386) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2018-07-07 |