| NPI | 1417738188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL 105780) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 7312) |
| 225700000X Massage Therapist (Licence: TX MT137388) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT9859) | |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2025-03-22 |