| NPI | 1063618189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA48205) |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: FL MA48205) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2010-03-01 |