| NPI | 1417227885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 15520) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA 60117543) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2012-01-03 |