| NPI | 1689446858 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ME MT7519) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: ME PA5717) |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2023-10-23 |