| NPI | 1730948563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ID MAS-3985) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA61048227) |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-03-14 |