| NPI | 1255102026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA61496208) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: ID MAS-5254) |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-01-11 |