| NPI | 1720529365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225500000X Specialist/Technologist (Licence: CA 205041) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 19734) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |