| NPI | 1750995387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KS CL-28822) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MO 2009021391) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |