| NPI | 1326237934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00023976) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA00023976) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2024-03-11 |