| NPI | 1588213409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WA LP00045933) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60021990) |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2025-04-15 |