| NPI | 1538819677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: 26-815) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 26815) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2024-03-05 |