| NPI | 1902524143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT118145) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX 118145) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2022-08-15 |