| NPI | 1396346177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA P161037222) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA61108011) |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2024-12-12 |