| NPI | 1538875299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CO MT.0018679) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CO q201038) |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2023-01-26 |