| NPI | 1710364914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MI M451387) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MI L672858) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2022-07-21 |