| NPI | 1104525609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: PA MSG014361) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WV 2022-3949) |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2023-02-23 |