| NPI | 1912704339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MI 7501015684) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IN MT22408522) |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2025-02-25 |