| NPI | 1396178265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NJ 18KT00069800) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NJ 18T00069800) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2023-04-25 |