| NPI | 1356051064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: IN MT21605787) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.022928) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-05 |