| NPI | 1346994647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NC 16989) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 75728) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-02-07 |