| NPI | 1871207365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA61381171) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: ME MT3894) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-01-09 |