| NPI | 1083592083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 51959) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 741012) |
| Enumeration Date | 2025-08-26 |
| Last Update Date | 2025-08-26 |