| NPI | 1295607455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MI 7501013052) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.018673) |
| Enumeration Date | 2025-09-18 |
| Last Update Date | 2025-09-18 |