| NPI | 1821278243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA33000) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: FL MA33000) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2016-05-16 |