| NPI | 1003293309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MT60791072) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: WA OC60483333) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2017-11-20 |