| NPI | 1265805311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 21049) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60495820) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2015-11-10 |