| NPI | 1497063150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60174955) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: WA 60174955) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2010-10-20 |