| NPI | 1982931622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO 3463) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI 6082) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2009-11-17 |