| NPI | 1912783804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA61452783) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 27751) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2023-09-06 |