| NPI | 1003552910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MI 7501017099) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 032972) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2026-05-16 |