| NPI | 1952610503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ MT-25350) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA48778) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2020-08-11 |