| NPI | 1124718556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT029279) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 883861) |
| 163WM1400X Registered Nurse, Nurse Massage Therapist (NMT) (Licence: TX MT029279) | |
| 171400000X Health & Wellness Coach (Licence: NA) | |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2023-05-09 |