| NPI | 1669177150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA73122) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL 77122) |
| 225700000X Massage Therapist (Licence: FL MA77122) | |
| 225700000X Massage Therapist (Licence: FL 73122) | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-04-03 |