| NPI | 1144015231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL 54031) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA54031) |
| Enumeration Date | 2025-04-10 |
| Last Update Date | 2025-05-07 |