| NPI | 1760103212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA61408846) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 26877) |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2024-04-12 |