| NPI | 1114425238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60815760) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MA60815760) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2019-06-06 |