| NPI | 1003116286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11003668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL APRN11003688) |
| 225700000X Massage Therapist (Licence: FL MA51731) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2022-02-17 |