| NPI | 1144005430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: GA MT015387) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA100279) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2025-06-19 |