| NPI | 1891944005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA30621) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 27 010507) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2008-09-11 |