| NPI | 1831697127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VA 0019016105) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: VA CNS18875) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2023-11-08 |