| NPI | 1831970789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 94373) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX 134066) |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2023-10-06 |