| NPI | 1720674138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD R01010) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019007996) |
| 225700000X Massage Therapist (Licence: DC MT1231) | |
| Enumeration Date | 2020-12-19 |
| Last Update Date | 2020-12-19 |