| NPI | 1831861046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ID MASG-812) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00014647) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2025-04-28 |