| NPI | 1669220141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: SC 13771) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 033337) |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2025-12-10 |