| NPI | 1003420571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT137693) |
| Additional Taxonomies | 171W00000X Contractor (Licence: GA MT012150) |
| 225700000X Massage Therapist | |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2023-07-10 |