| NPI | 1336866680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 020730) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 323481) |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2022-10-26 |