| NPI | 1528924867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ LMT-19193) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 100252) |
| Enumeration Date | 2025-12-30 |
| Last Update Date | 2025-12-30 |