| NPI | 1548947989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT130587) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 84708) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-06-28 |