| NPI | 1265198238 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ME MT7404) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA61213592) |
| Enumeration Date | 2021-11-13 |
| Last Update Date | 2023-11-02 |