| NPI | 1023656659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 25247) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT132794) |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2021-12-31 |