| NPI | 1528175445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00024952) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2023-03-20 |