| NPI | 1598096430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA56740) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2015-07-07 |