| NPI | 1588424824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KS 2023-013) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MO 2020029660) |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-03-21 |