| NPI | 1467736892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA64236) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60225795) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2015-10-04 |