| NPI | 1013469915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: GA MT009639) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: GA MT009639) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2024-05-06 |