| NPI | 1215296090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA 68053) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: FL 15904) |
| 376J00000X Homemaker (Licence: FL 15904) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2013-07-01 |