| NPI | 1265730410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA 46170) |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2021-12-03 |