| NPI | 1659767226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60519542) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: WA NU60333835) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-05-18 |