| NPI | 1356151989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 28734) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200840875RN) |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-01-07 |