| NPI | 1245619402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60814904) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA 60529305) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2021-04-30 |