| NPI | 1881313492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: CA 89210) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA 288518) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2022-08-25 |