| NPI | 1518725258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 27935) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ 24206) |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |