| NPI | 1487330817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NC 20746) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KY 282801) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-06-21 |