| NPI | 1457528002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: DC MT1016) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019006781) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-16 |