| NPI | 1881258358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AK 139644) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT-15055) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |