| NPI | 1306393657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: IL 227.009591) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60714530) |
| Enumeration Date | 2016-09-03 |
| Last Update Date | 2022-07-21 |