| NPI | 1487879318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MTO18362) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6676) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2025-09-11 |