| NPI | 1174970362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA61162860) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA CG60630674) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2022-08-15 |