| NPI | 1205506565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA 61044924) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 25395) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-09-17 |