| NPI | 1982777694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA00010448) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC00002835) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2025-09-11 |