| NPI | 1306187190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: KY 108532) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA64622) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2018-06-28 |