| NPI | 1124355581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60118854) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA60118854) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2009-12-02 |