| NPI | 1629589965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA61396888) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P160783235) |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2024-04-02 |