| NPI | 1467164160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M06244) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT135503) |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2022-12-14 |