| NPI | 1023315090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WI0500X Registered Nurse, Infusion Therapy (Licence: IA 090478) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 090478) |
| 163WX0106X Registered Nurse, Occupational Health (Licence: IA 090478) | |
| 225700000X Massage Therapist (Licence: IA 006683) | |
| Enumeration Date | 2011-02-27 |
| Last Update Date | 2022-04-12 |