| NPI | 1245425628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00024619) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 12890) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2007-09-10 |