| NPI | 1588307912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 033781) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: PA MSG014497) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2025-01-20 |