| NPI | 1740050756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 80430) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO 0026158) |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-01-02 |