| NPI | 1518612001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CT 002118) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 012985) |
| 315D00000X Hospice, Inpatient | |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2022-02-14 |