| NPI | 1851783278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA 65820) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MM 27865) |
| Enumeration Date | 2015-02-22 |
| Last Update Date | 2022-03-28 |