| NPI | 1497369631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA37867) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AR ADH13462189) |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2020-09-04 |