| NPI | 1407138779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60222106) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WV 2011-2852) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2012-05-18 |