| NPI | 1013330828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: FL MA33391) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA33391) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2014-01-30 |