| NPI | 1851126619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL 103469) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 18667) |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-03 |