| NPI | 1891230017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M05250) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019004030) |
| Enumeration Date | 2016-12-24 |
| Last Update Date | 2016-12-24 |