| NPI | 1225438377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 19492) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 4194) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2023-02-20 |