| NPI | 1518378595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician Personal Care Attendant (Licence: FL 100094054) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA74015) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2020-08-14 |