| NPI | 1972941987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: LA 8218) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO 8834) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2021-02-15 |