| NPI | 1245738970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO MT.0019317) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2022-10-05 |