| NPI | 1215258033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M02198) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019011694) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2014-09-04 |