| NPI | 1538757182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD R03311) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019017876) |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2021-01-08 |