| NPI | 1881058998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA-61943) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT 14537) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2024-10-01 |