| NPI | 1972136703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NC 20514) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO MT.0023734) |
| 225700000X Massage Therapist (Licence: OH 33.013833) | |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2024-04-18 |