| NPI | 1730795105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225A00000X Music Therapist (Licence: DC MT0953) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA62383) |
| 225700000X Massage Therapist (Licence: VA 0019006223) | |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2020-09-21 |