| NPI | 1932377199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00008998) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA00008998) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2014-01-29 |