| NPI | 1689131393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: PA MSG014743) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60933901) |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2024-12-09 |