| NPI | 1932661352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MT lmt-lmt-lic-15881) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2024-05-05 |