| NPI | 1174915557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL MA19189) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL AL1688) |
| 225700000X Massage Therapist (Licence: FL MA19189) | |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2023-04-20 |