| NPI | 1720650815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: RI 01439) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NH 7829) |
| 225700000X Massage Therapist (Licence: NV 7209) | |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2021-07-16 |