| NPI | 1124528039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TN 12201) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2021-01-20 |