| NPI | 1245001775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT109639) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: AZ 1153553) |
| 171400000X (Licence: AZ 1153552) | |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-01-12 |