| NPI | 1184054827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA73373) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MM31067) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |