| NPI | 1679291538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M05957) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: PA MSG002338) |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2022-09-13 |