| NPI | 1487945671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ID 581598-09) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60111603) |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2011-04-22 |