| NPI | 1699426973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MS 2860) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AL 5849) |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2022-01-18 |