| NPI | 1235643594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60799234) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA 60799234) |
| Enumeration Date | 2017-11-24 |
| Last Update Date | 2023-01-15 |