Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MA33391 | FL |
NPI | 1013330828 |
---|---|
Provider Name | Mr. Wendell Diamal JR. |
First Address | Clermont, FL 34711-5932 |
Second Address | Clermont, FL 34711-5932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2014 |
Last Update Date | 30/01/2014 |