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 |