| NPI | 1376207357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL 32205) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.024889) |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2021-10-26 |