| NPI | 1588069967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: CA 42355) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 42355) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2021-03-26 |