| NPI | 1053428151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NH 692M) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA38765) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2008-09-05 |