| NPI | 1467960336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NM MT8347) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KY 171026) |
| Enumeration Date | 2018-01-13 |
| Last Update Date | 2023-06-26 |