| NPI | 1053119222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: GA MT014272) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 88378) |
| Enumeration Date | 2025-03-04 |
| Last Update Date | 2025-03-04 |