| NPI | 1841423456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NC 20138) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NC 20138) |
| Enumeration Date | 2009-08-29 |
| Last Update Date | 2024-11-21 |