| NPI | 1679383574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 10017676) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 25776) |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2025-01-13 |