| NPI | 1962835603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: DC MT1511) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019010788) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2013-08-16 |