| NPI | 1760987853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN61648998) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60780327) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2025-08-04 |