| NPI | 1730822750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WM1400X Registered Nurse, Nurse Massage Therapist (NMT) (Licence: MD R02610) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD R02610) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2022-04-18 |