| NPI | 1497265342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WV 2016-3457) |
| Additional Taxonomies | 175L00000X Homeopath |
| 251E00000X Home Health | |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2025-05-27 |