| NPI | 1912635210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WI 12373-146) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NJ 18KT01443600) |
| Enumeration Date | 2022-08-13 |
| Last Update Date | 2022-08-13 |