| NPI | 1568829745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ID mas4807) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60623287) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2024-10-08 |