| NPI | 1326689795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL Ma88643) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MM88643) |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2022-03-11 |