| NPI | 1366778771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 16215) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60115525) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2009-11-11 |