| NPI | 1568740264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 21091) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA60581) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2020-05-14 |