| NPI | 1619475563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AL 3794) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 37921) |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2022-07-21 |