| NPI | 1730845751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD R02723) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: DC MT2273) |
| Enumeration Date | 2021-11-14 |
| Last Update Date | 2021-11-14 |