| NPI | 1780338277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M05401) |
| Additional Taxonomies | 163WM1400X Registered Nurse, Nurse Massage Therapist (NMT) (Licence: MD M05401) |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2022-02-04 |