| NPI | 1992113443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA 40619727) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 19987) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2014-07-29 |