NPI | 1780957910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA60762) |
Enumeration Date | 2012-02-19 |
Last Update Date | 2015-09-30 |