| NPI | 1871832824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AK 101402) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: PA MSG004224) |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2019-08-19 |