| NPI | 1013844422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: CA 65917) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 65917) |
| Enumeration Date | 2026-05-07 |
| Last Update Date | 2026-08-10 |