| NPI | 1699530766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NM MT20230035) |
| Additional Taxonomies | 172P00000X Naprapath (Licence: NM DN2024-003) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2026-09-16 |