| NPI | 1922563592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NM 9006) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: PA MSG016713) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2026-06-01 |