| NPI | 1952803728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MN na) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MN 965025) |
| 172M00000X Mechanotherapist | |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2019-12-07 |