| NPI | 1720711518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL 100391) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MO 2011010553) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-07-08 |