| NPI | 1134691538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 76430) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 75430) |
| Enumeration Date | 2018-12-23 |
| Last Update Date | 2018-12-23 |