| NPI | 1285275362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 80230) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 49131) |
| 225700000X Massage Therapist | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2019-10-01 |