| NPI | 1992154157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO MT0017067) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ MT19288) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2016-06-08 |