| NPI | 1831966159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO MT.0024726) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227.023239) |
| 225700000X Massage Therapist (Licence: FL MA100471) | |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2023-12-06 |