| NPI | 1720359482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11006721) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA65506) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2020-06-16 |