| NPI | 1568714293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA38623) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AL 2456) |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2015-12-03 |