| NPI | 1790319440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AK 155567) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TN 8496) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2020-03-02 |