| NPI | 1336801968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: SC 12413) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 19490) |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2021-10-11 |