| NPI | 1497417075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CT 10425) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CT 2173) |
| 225700000X Massage Therapist (Licence: MA 16732) | |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2021-10-11 |