| NPI | 1326652801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NJ 18KT00671100) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 0126029) |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |