| NPI | 1730894379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MT012822) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: GA MT012822) |
| 225700000X Massage Therapist (Licence: FL MA90757) | |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2023-01-18 |