| NPI | 1396458535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 14894) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI 11376) |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2023-01-03 |