| NPI | 1881910248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KY 1158) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: KY 1539p) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2010-04-09 |