| NPI | 1558530758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00014741) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 7775) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2010-11-08 |