| NPI | 1235963737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AL 4329) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA105456) |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2024-08-27 |