| NPI | 1043449960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9250725) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA30334) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2013-02-05 |