| NPI | 1609401553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA61045418) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 2044) |
| 225700000X Massage Therapist (Licence: OR 24889) | |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-03-10 |