| NPI | 1750198537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA90497) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227022256) |
| Enumeration Date | 2024-12-14 |
| Last Update Date | 2024-12-14 |