| NPI | 1932251337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA 60404008) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WA RC00056511) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2016-04-19 |