| NPI | 1689422743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO 0024935) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 016309) |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-05-14 |