| NPI | 1316742224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 225700000X) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 57652) |
| Enumeration Date | 2025-02-14 |
| Last Update Date | 2025-02-14 |