| NPI | 1093005191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: DC MT124) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019002576) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-14 |