| NPI | 1689121816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA MA60449642) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH61345249) |
| 225700000X Massage Therapist (Licence: WA 60449642) | |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2023-02-13 |