| NPI | 1639485360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60148628) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CHIR.CH.70055884) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2026-06-05 |