| NPI | 1396999066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 018791) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019006540) |
| 225700000X Massage Therapist (Licence: SC 5170) | |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2008-11-08 |