| NPI | 1205950292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA# 10055) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO 7499) |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2010-03-18 |