| NPI | 1134352420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MT 877) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA56903) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2010-12-04 |