| NPI | 1922629161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: 249) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019008213) |
| 225700000X Massage Therapist (Licence: NC 17657) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2023-11-08 |