| NPI | 1588341226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VA 0019010859) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 16653) |
| Enumeration Date | 2023-07-04 |
| Last Update Date | 2023-07-04 |