| NPI | 1881921567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA ma60103755) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA 165644) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2009-11-17 |