| NPI | 1538820113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 42341) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CA 2000030720) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-01-05 |