| NPI | 1891184990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M04550) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD A4156) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2024-06-30 |