| NPI | 1912403064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: GA MT009371) |
| Additional Taxonomies | 173C00000X Reflexologist (Licence: GA MT009371) |
| 172A00000X Driver (Licence: GA 054444544) | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2018-04-05 |