| NPI | 1730996828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 550) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 015870) |
| Enumeration Date | 2024-12-12 |
| Last Update Date | 2024-12-12 |