| NPI | 1619431418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA91153) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2022-06-16 |