| NPI | 1477094027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 69971) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 101815) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2023-05-11 |