| NPI | 1134673379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 22079) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA 60629997) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2016-08-04 |