| NPI | 1720421308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA56728) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9330688) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2013-04-12 |