| NPI | 1275854374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60171973) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019006607) |
| 225700000X Massage Therapist (Licence: AL 3106) | |
| Enumeration Date | 2010-06-13 |
| Last Update Date | 2014-01-22 |