NPI | 1225375124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: NJ 18KT00134000) |
Additional Taxonomies | 225700000X Massage Therapist (Licence: NJ 18KT00134000) |
Enumeration Date | 2013-01-11 |
Last Update Date | 2023-02-08 |