| NPI | 1790094175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA45867) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: FL 698778920) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2016-11-12 |