| NPI | 1598435968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MI 7501014462) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5303000702) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-09-17 |