| NPI | 1952511107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA16972) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NC10019410) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |