| NPI | 1013073592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 18293) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TN 2526) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2014-01-16 |