| NPI | 1710596390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: HI MAT-17688-0) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO MT.0023181) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2024-10-11 |