| NPI | 1043469117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 533606) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 031276) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2021-09-14 |