| NPI | 1275371817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA61328621) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 28710) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-12-04 |