| NPI | 1609755743 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX 046868) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 171400000X Health & Wellness Coach | |
| Enumeration Date | 2025-09-02 |
| Last Update Date | 2025-09-02 |