| NPI | 1639946585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX 134304) |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |