| NPI | 1255649869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MA00015681) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00015681) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2025-05-09 |