| NPI | 1962384131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ MT-28740) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 20297) |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2025-07-21 |