| NPI | 1134798440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA89123) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 86243) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2021-06-21 |