| NPI | 1689643116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KY 106160) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000895A) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-12-30 |