| NPI | 1346705266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WV 2018-3609) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA79269) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2019-02-05 |