| NPI | 1508753062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: UT 7734967-4701) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 7734967-3502) |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2026-04-02 |