| NPI | 1497890180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA000010957) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00023380) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2011-10-22 |