| NPI | 1629653357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KY 175371) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.023866) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2021-03-15 |