| NPI | 1053683813 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172M00000X Mechanotherapist (Licence: OR 18501) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 18501) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2012-02-08 |