| NPI | 1508514258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 89791) |
| Additional Taxonomies | 332100000X Department of Veterans Affairs (VA) Pharmacy |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2022-10-28 |