| NPI | 1790288447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT107482) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT104482) |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2018-03-08 |