| NPI | 1275380081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VT 164.0001511) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NH 7346) |
| Enumeration Date | 2024-05-01 |
| Last Update Date | 2024-05-01 |