| NPI | 1780925107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 14735) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OR 201390797) |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2018-01-17 |