| NPI | 1124691167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 12794) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MA 16037) |
| 225700000X Massage Therapist (Licence: TX 110098) | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2021-07-19 |