| NPI | 1992685820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MD M06577) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019012669) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-09-03 |