| NPI | 1285908491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MA 1173) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA#9951) |
| 225700000X Massage Therapist (Licence: NY 010402-1) | |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2012-03-06 |