| NPI | 1215765292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 71008) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ MT-30051) |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2025-02-05 |