| NPI | 1316224439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60247265) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: WA MA60247265) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2013-09-24 |