| NPI | 1811102122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00019015) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 11195) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |