| NPI | 1952712358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT132983) |
| Additional Taxonomies | 171100000X Acupuncturist |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2021-08-02 |