| NPI | 1508235219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 14645) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA 00016097) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2015-09-23 |