| NPI | 1821211004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00021808) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NC10054879) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-18 |