| NPI | 1962937250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: DC MT1561) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2017-04-25 |