| NPI | 1811154826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist |
| Additional Taxonomies | 163WM1400X Registered Nurse, Nurse Massage Therapist (NMT) (Licence: FL MA0032581) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2023-04-18 |