| NPI | 1700153319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA 64775) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA64775) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2011-11-28 |