| NPI | 1528806213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA108187) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9299735) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-17 |