| NPI | 1902970296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA 00020866) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA00022138) |
| 225700000X Massage Therapist (Licence: OR 11901) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-09-09 |