| NPI | 1881307304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VA 0019018850) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 92359) |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2022-12-29 |