| NPI | 1982750378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 9273) |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 174400000X Specialist (Licence: OR 9273) | |
| 174H00000X Health Educator | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2022-11-02 |