| NPI | 1386026227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 21340) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA 60558376) |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2016-12-15 |