| NPI | 1982356945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA87802) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: SC 12666) |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2022-01-21 |