| NPI | 1194963140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA31405) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: FL CRT37209) |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2009-01-29 |