| NPI | 1407661507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 033427) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CT 11405) |
| Enumeration Date | 2025-02-07 |
| Last Update Date | 2025-02-07 |