| NPI | 1982195327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: LA 8782) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NH 4052) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2018-05-22 |