| NPI | 1295772499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 11938) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2012-09-10 |