| NPI | 1740582626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CT 10652) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL #MA54724) |
| Enumeration Date | 2010-11-25 |
| Last Update Date | 2023-09-25 |