| NPI | 1881011559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA 60472199) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 20095) |
| Enumeration Date | 2014-03-19 |
| Last Update Date | 2014-06-29 |