| NPI | 1689655458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 10250) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3622) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2013-01-19 |