| NPI | 1346817749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA90683) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: FL OTA17981) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2021-06-05 |