| NPI | 1679766828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175F00000X Naturopath (Licence: WA NT 60524196) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00023117) |
| 171100000X Acupuncturist (Licence: WA AC 60740047) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2017-05-04 |