| NPI | 1205545134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NJ 18KT01094600) |
| Additional Taxonomies | 174N00000X Lactation Consultant, Non-RN |
| Enumeration Date | 2022-11-18 |
| Last Update Date | 2023-08-15 |