| NPI | 1174095087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VA 0019016903) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT-14450) |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2018-12-18 |