| NPI | 1336853092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CT 11104) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 03317) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-01-09 |