| NPI | 1790981645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: GA MT000522) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA MT000522) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2023-02-09 |