| NPI | 1518245042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA 21935) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 21935) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2024-01-28 |