| NPI | 1558601674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60298052) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P160045527) |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2013-07-10 |