| NPI | 1306037494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TN MT1682) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019002993) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2007-08-05 |