| NPI | 1568795086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA 60026405) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 13755) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2024-11-13 |