| NPI | 1205469871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA 60909358) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 24737) |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2020-02-21 |