| NPI | 1740538628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 24898) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT 2885) |
| Enumeration Date | 2012-08-26 |
| Last Update Date | 2025-02-12 |