| NPI | 1568587194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 13614) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00023290) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |