| NPI | 1568485076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA27732) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9327458) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-07-12 |