| NPI | 1235529744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: WA MA60288991) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: WA Massage Therapist -) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2015-02-04 |