| NPI | 1013603174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: ND 22146) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ND R31784) |
| 163W00000X Registered Nurse (Licence: MN 2014874) | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-12 |