| NPI | 1609942531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60423885) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 10723) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2014-03-14 |