| NPI | 1982995817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA62829) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL HCC9395) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2020-12-18 |