| NPI | 1831739531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KY 107028) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: KY 252738) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2023-08-11 |