| NPI | 1780733634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MA00008870) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00008870) |
| 225700000X Massage Therapist | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2025-05-29 |