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 |