| NPI | 1851968960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: 7593) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MA 7593) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2021-06-07 |