| NPI | 1003279993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL 83633) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: FL in progress) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2024-09-12 |