| NPI | 1730200809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00019315) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC60243244) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2013-01-15 |