| NPI | 1730619131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ MT-28141) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA.60745513) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-01-04 |