| NPI | 1003163858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT135450) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225700000X Massage Therapist (Licence: FL MA79474) | |
| Enumeration Date | 2012-08-11 |
| Last Update Date | 2024-01-13 |