| NPI | 1659982858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT037254) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 765933) |
| 225700000X Massage Therapist (Licence: TX MI2983) | |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-08-11 |