| NPI | 1750813762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 023153) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA 60735769) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2022-02-21 |