| NPI | 1073795001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: DC MT1041) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 014240) |
| 225700000X Massage Therapist (Licence: TX MT045529) | |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-11-30 |