| NPI | 1154927481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M06130) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: DC MT2537) |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2020-12-10 |