| NPI | 1316217664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M03790) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: DC MT1077) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |