| NPI | 1245628312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NJ 26NR16310700) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NJ 18KT00409300) |
| Enumeration Date | 2014-12-24 |
| Last Update Date | 2014-12-24 |