| NPI | 1174683882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: DC MT231) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 2306000602) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |