| NPI | 1619685302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NJ 18KT00741300) |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2022-11-10 |