| NPI | 1699456970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: IN MT21906831) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: 22674) |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2023-07-28 |