| NPI | 1326359530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11013997) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA59504) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2021-09-30 |