| NPI | 1134995574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 89976) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: CA 01159762) |
| 376K00000X Nurse's Aide (Licence: CA 01159762) | |
| Enumeration Date | 2023-11-28 |
| Last Update Date | 2023-11-28 |