| NPI | 1861640294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA 00022515) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: WA MA00022515) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2021-10-25 |