| NPI | 1780056010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 21468) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 00190138888) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2015-10-26 |