| NPI | 1184397697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AL 4794) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: GA MT011546) |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2024-07-08 |