| NPI | 1740783869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA 61233543) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 71250) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2022-05-24 |