| NPI | 1134823685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: IN MT22007212) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.025342) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2023-03-29 |