| NPI | 1336699453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: UT 8269416-4701) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: ID MAS-2844) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2023-02-26 |