| NPI | 1225450554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VA 0019009414) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MD R01602) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |