| NPI | 1902049562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 17071) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60040619) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2020-09-27 |