| NPI | 1235698895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60922727) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 24844) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2021-03-22 |