| NPI | 1619137643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA 55891) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 017465) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2010-03-12 |