| NPI | 1801674361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NC 07961) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO 15659) |
| 225700000X Massage Therapist (Licence: TX 135843) | |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2023-09-18 |