| NPI | 1376063230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 82703) |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: CA 803905) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2023-04-20 |