| NPI | 1982970083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WY 96146) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA41296) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2012-03-27 |