| NPI | 1033208426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00018386) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NA00168831) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |