| NPI | 1316611056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 86976) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 029033) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2021-08-05 |