| NPI | 1548448269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VA 0019003820) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 5940) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2008-02-05 |