| NPI | 1588159586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 014116-1) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA32663) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-06-22 |