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 |