| NPI | 1093431520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 26328) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 74867) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2022-10-17 |