| NPI | 1154104586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: DC MT200001263) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019016254) |
| 225700000X Massage Therapist (Licence: MD R03568) | |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2023-08-17 |