| NPI | 1104316124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60854335) |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2023-10-25 |