| NPI | 1790373462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO MT.0027236) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 021508) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2025-10-23 |