| NPI | 1568274611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: LA 1929) |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 174H00000X Health Educator | |
| 374K00000X Religious Nonmedical Practitioner | |
| Enumeration Date | 2025-01-24 |
| Last Update Date | 2025-05-30 |