| NPI | 1376356261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M05797) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: DC MT2575) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-01-27 |