| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 171400000X |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 172M00000X Mechanotherapist |
| 173C00000X Reflexologist |
| 174H00000X Health Educator |
| 175F00000X Naturopath |
| 175L00000X Homeopath |
| 225400000X Rehabilitation Practitioner |
| 2255A2300X Specialist/Technologist Athletic Trainer |
| 225700000X Massage Therapist |
| 226300000X Kinesiotherapist |
| 246RP1900X Technician, Pathology Phlebotomy |
| 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2025-04-20 |