| NPI | 1215050620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00013560) |
| Additional Taxonomies | 171W00000X Contractor (Licence: WA MA00013560) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2019-11-14 |