| NPI | 1831490069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 295254) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 021140) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-04 |