| NPI | 1245827674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 1630524) |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: CO 07-07024) |
| 225700000X Massage Therapist (Licence: CO 0022025) | |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2020-12-31 |