| NPI | 1982840674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: MA 1887) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MA 2148) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2008-12-30 |