| NPI | 1942845508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CT 8295) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI 15944) |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2022-12-21 |