| 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 |