| NPI | 1942965702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT135840) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: M) |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2021-11-05 |