| NPI | 1265159206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT137288) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 173C00000X Reflexologist | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-24 |